Cédric Maillot1, Ciara Harman2, Loïc Villet3, Justin Cobb4, Charles Rivière5. 1. MSK Lab - Imperial College London; South West London Elective Orthopaedic Centre, Dorking Rd, Epsom KT18 7EG, UK. 2. SWLEOC Research centre, Dorking Rd, Epsom KT18 7EG, UK. 3. Centre de l'arthrose, 4 Rue Georges Negrevergne, 33700 Mérignac, France. 4. MSK Lab - Imperial College London; Charing Cross Campus, Laboratory Block, Hammersmith, London W6 8RP, UK. 5. MSK Lab - Imperial College London; South West London Elective Orthopaedic Centre, Dorking Rd, Epsom KT18 7EG, UK. Electronic address: c.riviere@imperial.ac.uk.
Abstract
INTRODUCTION: A systematic review was conducted to assess the clinical and radiological outcomes of the alternative surgical techniques that consider the dynamic aspect of the acetabular orientation when aligning a cup (pelvic tilt-, lumbo-pelvic kinematics-, and spine-hip relationship-adjusted cup alignment techniques). METHOD: Eight eligible articles reported the outcomes of total hip arthroplasty (THA) performed with alternative techniques. Clinical and radiological data were extracted. One study had a control group of patients who underwent conventional THAs (level III) while the seven other studies were level IV. Computer navigation system (CAS), Optimized Positioning System (OPS™), and manual instrumentation were used to align components in four, two, and two studies, respectively. A meta-analysis was not carried out because there was a lack of homogeneity between included articles regarding the method to position the cup and the nature of the reported data. RESULTS: THA performed with alternative techniques had an early dislocation rate ranging from 0 to 1.9%, no unexpected catastrophic failure, and acceptable radiographic cup orientations. One study compared kinematically and mechanically aligned THAs and found no dislocation in either groups, similar patient reported outcome measures (43 Oxford-12 Score for both groups), and similar proportions of cup in the Lewinnek zone (respectively 65% and 70%). DISCUSSION/ CONCLUSION: Alternative methods accounting for the functional acetabular orientation seem to be clinically safe and effective in the early-term, and generate acceptable cup orientation on radiographs. Their values compare to those of more conventional techniques for cup implantation remain to be determined. We developed a classification of the multiple methods for aligning an acetabular component. LEVEL OF EVIDENCE: IV, systematic review of level III and IV studies.
INTRODUCTION: A systematic review was conducted to assess the clinical and radiological outcomes of the alternative surgical techniques that consider the dynamic aspect of the acetabular orientation when aligning a cup (pelvic tilt-, lumbo-pelvic kinematics-, and spine-hip relationship-adjusted cup alignment techniques). METHOD: Eight eligible articles reported the outcomes of total hip arthroplasty (THA) performed with alternative techniques. Clinical and radiological data were extracted. One study had a control group of patients who underwent conventional THAs (level III) while the seven other studies were level IV. Computer navigation system (CAS), Optimized Positioning System (OPS™), and manual instrumentation were used to align components in four, two, and two studies, respectively. A meta-analysis was not carried out because there was a lack of homogeneity between included articles regarding the method to position the cup and the nature of the reported data. RESULTS: THA performed with alternative techniques had an early dislocation rate ranging from 0 to 1.9%, no unexpected catastrophic failure, and acceptable radiographic cup orientations. One study compared kinematically and mechanically aligned THAs and found no dislocation in either groups, similar patient reported outcome measures (43 Oxford-12 Score for both groups), and similar proportions of cup in the Lewinnek zone (respectively 65% and 70%). DISCUSSION/ CONCLUSION: Alternative methods accounting for the functional acetabular orientation seem to be clinically safe and effective in the early-term, and generate acceptable cup orientation on radiographs. Their values compare to those of more conventional techniques for cup implantation remain to be determined. We developed a classification of the multiple methods for aligning an acetabular component. LEVEL OF EVIDENCE: IV, systematic review of level III and IV studies.
Authors: Joost H J van Erp; Thom E Snijders; Harrie Weinans; René M Castelein; Tom P C Schlösser; Arthur de Gast Journal: Arch Orthop Trauma Surg Date: 2021-06-08 Impact factor: 2.928
Authors: Bernard H van Duren; Joseph M Royeca; Conor M Cunningham; Jonathan N Lamb; Chris J Brew; Hemant Pandit Journal: Hip Int Date: 2020-08-04 Impact factor: 2.135
Authors: Jeffrey M Muir; Kelly A Foley; Karlina Fiaes; Justin B Wagler; Milena Galaszewicz; Jessica R Benson; Michael P Bradley Journal: Cureus Date: 2021-06-09